Myeloma Flashcards
What is the definition of myeloma
Cancer of plasma cells (B lymphocytes which produce immunoglobulins) due to a genetic mutation causing them to divide uncontrollably.
What are some secondary problems of myeloma?
Renal disease
Bones
Anaemia
Anaemia in myeloma
Plasma cells invade BM causing suppression of development of other blood cells
Results in anaemia, thrombocytopenia and neutropenia
Why does myeloma result in renal disease? (4)
Increased immunoglobulins block flow through tubules
Hypercalcaemia impairs renal function
Dehydration
Medications, such as bisphosphonates, harm the kidney
What affect does myeloma have on bone?
Increased osteoclast and reduced osteoblast function = resorption > construction
Cytokines released from plasma and stromal cells cause osteolytic lesions (areas of weakess) and pathological fractures
Common locations of myeloma bone disease?
Spine
Skull
Ribs
Long bones
Common #s in myeloma?
Vertebral #
Femur #
What problems are associated with hyperviscosity
Easy bruising and bleeding
Heart failure
Visual change due to vascular eye disease
RF for myeloma
Old Male Obese Black African FHx
Suspection of myeloma
Any person >65 with back / bone pain / unexplained fractures
What initial investigations when suspecting myeloma?
If still suspicious, what next?
FBC
Calcium
ESR
Plasma viscosity
Bence Jones protein (urine electrophoresis)
Testing for myeloma
Bence-Jones protein (urine electrophoresis)
Serum free light-chain assay
Serum immunoglobulins
Serum protein electrophoresis
BM biopsy
Imaging: whole body CT/MRI, skeletal survey
What signs seen on XR are suspicous of myeloma?
Lytic lesions
Punched out lesions
Raindrop skull
Management of myeloma
Chemotherapy SC transplant VTE prophlaxis Radiotherapy Orthopaedic surgery Bisphosphonates Cement augmentation
Complications of myeloma
Infection Pain Renal failure Anaemia Hypercalcaemia Peripheral neuropathy SCC Hyperviscosity
